Wilson Professional Dental Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WILSON PROFESSIONAL DENTAL CORPORATION

Practice address

31103 Rancho Viejo Rd Ste D5
San Juan Capistrano, CA 92675-1759

Phone

(949) 661-3380

NPI assigned

May 22, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mandi Lynn Wilson, DDS

Title

Dentist

Phone

(903) 330-4661

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558483200000",
    "number": "1497312888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21020 PACIFIC CITY CIR UNIT 2423",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926488516",
            "telephone_number": "903-330-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31103 RANCHO VIEJO RD STE D5",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751759",
            "telephone_number": "949-661-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-05-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MANDI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "903-330-4661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Willett
• William Dao Dental Group
• Kathryn Denise Williams, M.S., CCC
• Sharika Earline Williams
• Catherine Lea Wilms
• Charles Orin Wilson II, D.D.S.
• Eric S Wilson, DDS
• Jay Wohlgemuth
• Judith Wolder, MA, LMFT
• Wolfgang Labs Inc

• Dental Clinic/Center in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.